Hip oral core topics

Paul A. Banaszkiewicz

doi:10.1017/CBO9780511795152.016

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Chapter 14 - Hip oral core topics

from Section 4 - The adult elective orthopaedics oral

Paul A. Banaszkiewicz

Edited by

Paul A. Banaszkiewicz and

Deiary F. Kader

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Paul A. Banaszkiewicz: Affiliation:
Queen Elizabeth Hospital, Gateshead, UK
Paul A. Banaszkiewicz: Affiliation:
Queen Elizabeth Hospital, Gateshead
Deiary F. Kader: Affiliation:
Queen Elizabeth Hospital, Gateshead

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Summary

Anatomy of the hip

The applied surgical anatomy of the hip joint is a subject with which you must be comfortable. Most examiners expect a trainee sitting the exit exam to know the anatomy and surgical approaches to the hip joint inside out. Two broad categories of question are asked:

Surgical approaches to the hip joint
Colour atlas photographs of hip joint anatomy (+/− bare labels).

Surgical approaches

It is odds-on that you will be asked about this during either the intermediate cases discussion or the basic science oral. It is not unusual to be asked in the adult elective orthopaedic or trauma oral.

Type: Chapter
Information: Postgraduate Orthopaedics
The Candidate's Guide to the FRCS (Tr and Orth) Examination
, pp. 170 - 217

DOI: https://doi.org/10.1017/CBO9780511795152.016 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2012

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References

Extra material available onwww.postgraduateorthopaedics.com

The extracapsular arterial ring is sometimes referred to as the trochanteric anastomosis in textbooks

Gautier, EGanz, KKrügel, NGill, TGanz, R 2000 Anatomy of the medial femoral circumflex artery and its surgical implicationsJournal of Bone and Joint Surgery [Br] 82 679CrossRef Google Scholar PubMed

An absolutely must-know topic as virtually every candidate seems to be asked about AVN in one guise or another during the FRCS (Tr & Orth) exam

When mentioning causes of AVN stick to the most common ones first

Some examiners are now asking about this classification system rather than the better known Ficat or Steinberg system

Functional exploration of bone includes IM venogram, bone marrow pressure and core biopsy

Easy to mix up and say that the Steinberg classification is a six-stage system because you remember the number 6

Mitchell, DGRao, VMDalinka, MK 1987 Femoral head necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findingsRadiology 162 709CrossRef Google Scholar PubMed

This classification grading was recently asked by one of the examiners

Agarwala, SShah, SJoshi, VR 2009 The use of alendronate in the treatment of avascular necrosis of the femoral head: follow-up to eight yearsJournal of Bone and Joint Surgery [Br] 91 1013CrossRef Google Scholar PubMed

Ohzono, KSugano, NTakaoka, K 1991 Natural history of nontraumatic avascular necrosis of the femoral headJournal of Bone and Joint Surgery [Br] 73 68CrossRef Google Scholar PubMed

Play it safe

Reis, NDSchwartz, OMilitianu, D 2003 Hyperbaric oxygen therapy as a treatment for stage-I avascular necrosis of the femoral headJournal of Bone and Joint Surgery [Br] 85 371CrossRef Google Scholar PubMed

Geoff Boycott

Mont, MACarbone, JJFairbank, AC 1996 Core decompression versus nonoperative management for osteonecrosis of the hipClinical Orthopaedics and Related Research 324 169CrossRef Google Scholar

Tanzer, MBobyn, JDKrygier, JJKarabasz, D 2008 Histopathologic retrieval analysis of clinically failed porous tantalum osteonecrosis implantsJournal of Bone and Joint Surgery [Am] 90 1282CrossRef Google Scholar PubMed

Sugioka, YHotokebuchi, TTsutsui, H 1992 Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term resultsClinical Orthopaedics and Related Research 277 111Google Scholar

Mentioning this particular osteotomy to the examiners is inviting an imminent looming disaster to occur

Mont, MAZywiel, MGMarker, DR 2010 The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic reviewJournal of Bone and Joint Surgery [Am] 92 2165CrossRef Google Scholar

Nam, KWKim, YL 2008 Fate of untreated asymptomatic osteonecrosis of the femoral headJournal of Bone and Joint Surgery [Am] 90 477CrossRef Google Scholar PubMed

Kantor, SGHuo, MHHuk, OLSalvati, EA 1996 Cemented total hip arthroplasty in patients with osteonecrosis: a 6-year minimum follow-up study of second-generation cement techniquesJournal of Arthroplasty 11 267CrossRef Google Scholar PubMed

Mont, MAJones, LCHungerford, DS 2006 Nontraumatic osteonecrosis of the femoral head: ten years laterJournal of Bone and Joint Surgery [Am] 88 1117Google Scholar PubMed

Mont, MAHungerford, DS 1995 Non-traumatic avascular necrosis of the femoral headJournal of Bone and Joint Surgery [Am] 77 459CrossRef Google Scholar PubMed

The British Orthopaedic Association conference is a meeting that may be useful to attend prior to the exam, but it is not vital

No, I had not!

Hirst, PEsser, MMurphy, JCHardinge, K 1987 Bone grafting for protrusio acetabuli during total hip replacement. A review of the Wrightington method in 61 hipsJournal of Bone and Joint Surgery [Br] 69 229CrossRef Google Scholar PubMed

The examiner may be picky and try to catch you out with this one

This is classic adult elective orthopaedic oral material

Remember O5R2MAP

Garcia-Cimbrelo, EDiaz-Martin, AMadero, RMunera, L 2000 Loosening of the cup after low-friction arthroplasty in patients with acetabular protrusion. The importance of the position of the cupJournal of Bone and Joint Surgery [Br] 82 108CrossRef Google Scholar PubMed

Bayley, JCChristie, MJEwald, FCKelley, K 1987 Long-term results of total hip arthroplasty in protrusio acetabuliJournal of Arthroplasty 2 275CrossRef Google Scholar PubMed

Hartofilakidis, GStamos, KKarachalios, T 1998 Treatment of high dislocation of the hip in adults with total hip arthroplasty. Operative technique and long-term clinical resultsJournal of Bone and Joint Surgery [Am] 80 510CrossRef Google Scholar PubMed

McQueary, FGJohnston, RC 1988 Coxarthrosis after congenital dysplasia. Treatment by total hip arthroplasty without acetabular bone-graftingJournal of Bone and Joint Surgery [Am] 70 1140CrossRef Google Scholar PubMed

Linde, FJensen, JPilgaard, S 1988 Charnley arthroplasty in osteoarthritis secondary to congenital dislocation or subluxation of the hipClinical Orthopaedics 227 164Google Scholar PubMed

Lewinnek, GELewis, JLTarr, RCompere, CLZimmerman, JR 1978 Dislocations after total hip-replacement arthroplastiesJournal of Bone and Joint Surgery [Am] 60 217CrossRef Google Scholar PubMed

www.postgraduateorthopaedics.com

‘Several patient risk factors for dislocation after THA have been identified and these include

Hedlundh, UAhnfelt, LHybbinette, CHWeckstrom, JFredin, H 1996 Surgical experience related to dislocations after total hip arthroplastyJournal of Bone and Joint Surgery [Br] 78 206CrossRef Google Scholar PubMed

Woo, RYMorrey, BF 1982 Dislocations after total hip arthroplastyJournal of Bone and Joint Surgery [Am] 64 1295CrossRef Google Scholar PubMed

Be careful with this topic

Lidwell, OMLowbury, EJWhyte, WBlowers, RStanley, SJLowe, D 1982 Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised studyBritish Medical Journal (Clinical Research Ed) 285 10CrossRef Google Scholar PubMed

Be sensible (and practical) with your answers

Glithero, PRGrigoris, PHerding, LK 1993 White cell scans and infected joint replacements. Failure to detect chronic infectionJournal of Bone and Joint Surgery [Br] 75 371CrossRef Google Scholar PubMed

Robbins, GMMasri, BAGarbuz, DSDuncan, CP 2002 Evaluation of pain in patients with apparently solidly fixed total hip arthroplasty componentsJournal of the American Academy of Orthopaedic Surgeons 10 86CrossRef Google Scholar PubMed

Mirra, JMAmstutz, HCMatos, MGold, R 1976 The pathology of the joint tissues and its clinical relevance in prosthesis failureClinical Orthopaedics and Related Research 117 221Google Scholar

Polymorphs are only a significant component of the inflammatory cell infiltrate in infection

Lonner, JHDesai, PDicesare, PESteiner, GZuckerman, JD 1996 The reliability of analysis of intraoperative frozen sections for identifying active infection during revision hip or knee arthroplastyJournal of Bone and Joint Surgery [Am] 78 1553CrossRef Google Scholar PubMed

Zimmerli, WTrampuz, AOchsner, PE 2004 Prosthetic-joint infectionsNew England Journal of Medicine 351 1645CrossRef Google Scholar PubMed

Buchholz, HWElson, RAEngelbrecht, E 1981 Management of deep infection of total hip replacementJournal of Bone and Joint Surgery [Br] 63 342CrossRef Google Scholar PubMed

Wroblewski, BM 1986 One-stage revision of infected cemented total hip arthroplastyClinical Orthopaedics and Related Research 211 103Google Scholar

McDonald, DJFitzgerald, RHIlstrup, DM 1989 Two-stage reconstruction of a total hip arthroplasty because of infectionJournal of Bone and Joint Surgery [Am] 71 828CrossRef Google Scholar

Hanssen, ADOsmon, DR 2000 Assessment of patient selection criteria for treatment of the infected hip arthroplastyClinical Orthopaedics 381 91CrossRef Google Scholar

Matar, WYJafari, SMRestrepo, C 2010 Preventing infection in total joint arthroplastyJournal of Bone and Joint Surgery [Am] 92 36CrossRef Google Scholar PubMed

Gruen, TAMcNeice, GMAmstutz, HC 1979 ‘Modes of failure’ of cemented stem-type femoral components: a radiographic analysis of looseningClinical Orthopaedics and Related Research 141 17Google Scholar

One line is drawn from the anterior superior iliac spine to the centre of the acetabular socket

Try not to get them the wrong way round! The examiners will be happy to point this mistake out to you

Barrack, RLMulroy, RDHarris, WH 1992 Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic reviewJournal of Bone and Joint Surgery [Br] 74 385CrossRef Google Scholar PubMed

Mulroy, WFEstok, DMHarris, WH 1995 Total hip arthroplasty with use of so-called second-generation cementing techniques. A fifteen-year-average follow-up studyJournal of Bone and Joint Surgery [Am] 77 1845CrossRef Google Scholar PubMed

Jasty, MMaloney, WJBragdon, CR 1991 The initiation of failure in cemented femoral components of hip arthroplastiesJournal of Bone and Joint Surgery [Br] 73 551CrossRef Google Scholar PubMed

I believe most examiners prefer candidates to take the initiative in any discussion

This was obviously still in the good old exam days of accepted unpolitical correctness

The examiner is looking for a very specific term and wants this term to be mentioned and nothing else

Described as ‘more difficult than drawing blood from a stone’. Various different reasons for this

Restrepo, CPost, ZDKai, BHozack, WJ 2010 The effect of stem design on the prevalence of squeaking following ceramic-on-ceramic bearing total hip arthroplastyJournal of Bone and Joint Surgery [Am] 92 50CrossRef Google Scholar PubMed

There have been at least two published series of resurfacing hip arthroplasties in rheumatoid patients

Carrothers, ADGilbert, REJaiswal, ARichardson, JB 2010 Birmingham hip resurfacing: the prevalence of failureJournal of Bone and Joint Surgery [Br] 92 1344CrossRef Google Scholar

The great debate of whether and when to quote papers

I always found remembering author names easier if you can also remember the institution

Pandit, HGlyn-Jones, SMcLardy-Smith, P 2008 Pseudotumours associated with metal-on-metal hip resurfacingsJournal of Bone and Joint Surgery [Br] 90 847CrossRef Google Scholar PubMed

Grammatopoulos, GPandit, HGlyn-Jones, S 2010 Optimal acetabular orientation for hip resurfacingJournal of Bone and Joint Surgery [Br] 92 1072CrossRef Google Scholar PubMed

Ollivere, BDarrah, CBarker, TNolan, JPorteous, MJ 2009 Early clinical failure of the Birmingham metal-on-metal hip resurfacing is associated with metallosis and soft-tissue necrosisJournal of Bone and Joint Surgery [Br] 91 1025CrossRef Google Scholar PubMed

McBryde, CWTheivendran, KThomas, AMC 2010 The influence of head size and sex on the outcome of Birmingham hip resurfacingJournal of Bone and Joint Surgery [Am] 92 105CrossRef Google Scholar PubMed

Bollard, BJRCulliford, DJLangton, DJ 2010 High failure rates with a large-diameter hybrid metal-on-metal total hip replacementJournal of Bone and Joint Surgery [Br] 93 608Google Scholar

De Smet, KCampbell, PAGill, HS 2010 Metal-on-metal hip resurfacing: a consensus from the advanced hip resurfacing course, Ghent, June 2009Journal of Bone and Joint Surgery [Br] 92 335CrossRef Google Scholar

Forty is the new forty-five

The management dilemma of the young arthritic hip. This is a common hip scenario and a difficult clinical problem

Examiner

Brooker, AFBowerman, JWRobinson, RARiley, LH 1973 Ectopic ossification following total hip replacement. Incidence and a method of classificationJournal of Bone and Joint Surgery [Am] 55 1629CrossRef Google Scholar

Horwitz, BRRockowitz, NLGoll, SR 1993 A prospective randomized comparison of two surgical approaches to total hip arthroplastyClinical Orthopaedics and Related Research 291 154Google Scholar

Kim, YYKo, CUAhn, JYYoon, YSKwak, BM 1988 Charnley low friction arthroplasty in tuberculosis of the hip. An eight to 13-year follow-upJournal of Bone and Joint Surgery [Br] 70 756CrossRef Google Scholar PubMed

Book contents

Chapter 14 - Hip oral core topics

Summary

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